Healthcare Provider Details

I. General information

NPI: 1326189895
Provider Name (Legal Business Name): ASSOCIATED UROLOGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST STE 109-112
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST STE 109-112
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-8706
  • Fax:
Mailing address:
  • Phone: 708-423-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: KERMITT DAN HOYME
Title or Position: PHYSICIAN
Credential: MD, FACS
Phone: 708-423-8706